| Abstract: | 「疼痛」不僅為組織受傷後的原始感覺，更為主觀的、複雜的心理經驗。與疼痛相關的理論多強調，個體本身的主觀經驗與相關的心理社會因素會對疼痛有重要的影響，特別是慢性疼痛。目前台灣臨床上對慢性疼痛的診斷與評估，仍仰賴簡單的病史與實驗室及影像學檢查，而治療主要仍以給予藥物緩解疼痛為主，缺乏對患者疼痛問題的完整評估工具來進行評估及追蹤。本計畫將以「生理-心理-社會模式」為理論基礎，發展「台灣疼痛評估量表(Pain Assessment Scale Taiwan, PAST)」，作為臨床上全面性評估患者疼痛情況之工具，並能篩選出以目前常規治療較無效，可能需要心理治療介入的患者。本計畫將以中、高齡慢性疼痛患者為對象，第一年(進行中)將進行文獻回顧，並以焦點詢問法訪問有疼痛問題之中、高齡患者，與訪問疼痛科專科臨床醫師，收集相關之現象資料，由此草擬量表初始題項，以期在量表內容部份能充份涵蓋台灣人感知之疼痛現象及相關心理社會因素。第二年(本次申請)將進行「台灣疼痛評估量表」之完整信效度分析，除內部一致性、建構效度、及同時效標關聯效度外，並請臨床醫師評估回診患者，是否有合理疼痛改善作為預測效度，以建立具有完整心理計量特性資料，且臨床上可用之量表。
Pain is not only a nociception which caused by tissue damage but a subjective, complex experience. Many theories focusing on pain like the “Gate Control Theory,” the “Fear-Avoidance Model,” and the “Bio-Psycho-Social Model” all suggested that individual’s subjective experiences and pain-related psychosocial factors have significant roles on the phenomena of pain, especially in chronic pain. However, the clinical reality of pain management in Taiwan is still focusing on biomedical model. Most of the time, we relied on laboratory examinations, medical images, and a brief medical history to evaluate a person with chronic pain, and using medications to relief its pain. To most of the healthcare personnel in the field of pain management, it is not that we lack the knowledge or intention to evaluate comprehensively and to follow up, but it’s that even if we wanted to, we don’t have proper tools to use. Thus, the current study aimed to develop a scale, the “Pain Assessment Scale Taiwan (PAST),” for use in evaluating people with pain in clinical settings. The PAST aimed to cover not only the biomedical part of pain experiences, but also the psychosocial parts (e.g. emotions, cognitions, and behaviors related to pain). The PAST is also expected to serve as a screening tool that could pick-up those who might not improve by regular medical treatments per se but also needed psychological interventions. During the 1st year of this study (currently in progress), we plan to establish the items for PAST by “literature review,” “focus interview: people with pain problems,” and “focus interview: pain clinic physicians.” The main reason to use this sophisticated approach is that we want to cover the phenomena of chronic pain as thoroughly as possible. During the 2nd year (this application), we plan to establish the psychometric properties of the PAST, including internal consistency (as a reliability index), explanatory and confirmatory factor analysis (as indexes for construct validity), and correlations with other well-established scales (as for concurrent criterion-related validity). Furthermore, we will invite physicians to evaluate if their patient’s improvement of pain is medically reasonable, and use it as an index of predictive validity. Following through the process mentioned above, we expected to build a comprehensive and clinical suitable tool, the PAST, for evaluating persons with pain (especially chronic pain) in Taiwan. |
